Anxiety and Depression Trend
library(tidyverse)
library(viridis)
library(plotly)
knitr::opts_chunk$set(
echo = TRUE,
warning = FALSE,
fig.width = 8,
fig.height = 6,
out.width = "90%"
)
options(
ggplot2.continuous.colour = "viridis",
ggplot2.continuous.fill = "viridis"
)
scale_colour_discrete = scale_colour_viridis_d
scale_fill_discrete = scale_fill_viridis_d
theme_set(
theme_minimal() +
theme(
legend.position = "bottom",
plot.title = element_text(hjust = 0.5)
)
)Data Source
IPUMS Health Surveys: NHIS is a harmonized set of data covering more than 50 years (1963-present) of the National Health Interview Survey (NHIS). The NHIS is the principal source of information on the health of the U.S. population, covering such topics as general health status, the distribution of acute and chronic illness, functional limitations, access to and use of medical services, insurance coverage, and health behaviors. On average, the survey covers 100,000 persons in 45,000 households each year. The IPUMS NHIS facilitates cross-time comparisons of these invaluable survey data by coding variables identically across time. Our analysis will use data from 2015 to 2021, which covers the COVID-19 period.
Map: Percent of adults reporting any mental illness by state between 2019-2020
state_mental=
plot_usmap(
data = mental_df,
regions = "state",
values = "any_mental_per",
labels = TRUE, label_color = "white") +
labs(
title = "Percent of adults reporting any mental illness for each state, 2019-2022"
) +
scale_fill_continuous(
name = "Mental illness percent (%)",
label = scales::comma) +
theme(legend.position = "right")
ggplotly(state_mental)According to the mental health data collected between 2019 -2020, the mental illness percents are high in the US overal, with variations between states.
Any/Serious Mental illness numbers (million), by region, 2019-2020
any_mental_plot =
mental_df %>%
group_by(region) %>%
drop_na() %>%
summarize(any_mental_num = sum(any_mental_num)) %>%
ggplot(
aes(x = region, y = any_mental_num, fill = region)) +
geom_bar(stat = "identity") +
labs(
title = "Any Mental Illness Number, by Region, 2019-2020",
x = "Region",
y = "Mental illness number (million)",
fill = "Region") +
theme(legend.position = "bottom")
ser_mental_plot =
mental_df %>%
group_by(region) %>%
drop_na() %>%
summarize(ser_mental_num = sum(ser_mental_num)) %>%
ggplot(
aes(x = region, y = ser_mental_num, fill = region)) +
geom_bar(stat = "identity") +
labs(
title = "Serious Mental Illness Number, by Region, 2019-2020",
x = "Region",
y = "Mental illness number (million)",
fill = "Region") +
theme(legend.position = "bottom")
grid.arrange(any_mental_plot, ser_mental_plot, ncol =2) 
Comment Both any mental illness and serious mental illness are highest in the South, lowest in the northeast.
Any/Serious Mental illness percent, Top 10 states, 2019-2020
any_top10_plot =
mental_df %>%
filter(row_number(desc(any_mental_per)) <= 10) %>%
mutate(
state = fct_reorder(state, any_mental_per)
) %>%
ggplot(
aes(x = any_mental_per, y = state, fill = state)) +
geom_bar(stat = "identity") +
labs(
title = "Any Mental Illness Percent, Top 10 States",
x = "Any Mental illness percent (%)",
y = "State",
fill = "State") +
theme(legend.position = "bottom")
ser_top10_plot =
mental_df %>%
filter(row_number(desc(ser_mental_per)) <= 10) %>%
mutate(
state = fct_reorder(state, ser_mental_per)
) %>%
ggplot(
aes(x = ser_mental_per, y = state, fill = state)) +
geom_bar(stat = "identity") +
labs(
title = "Serious Mental Illness Percent, Top 10 States",
x = "Serious mental illness percent (%)",
y = "State",
fill = "State") +
theme(legend.position = "bottom")
grid.arrange(any_top10_plot, ser_top10_plot, ncol =2) 
Comment
The top 10 states for any and serious mental illness are 8/10 the same, except Washington, Rhode Island, Arkansas and Indiana. Ultah has the highest any/serious mental illness percent.
Depression and anxiety
data cleaning
nhis =
=======
Data cleaning
We pulled out data from IPUMS Health Surveys: NHIS and will limit our
analysis using data from 2015 to 2021. To analyze the trend of anxiety
prevalence, frequency and level from 2015 to 2021, we will focus on
anxiety indicators listed below:
- WORFREQ:How often feel worried, nervous, or anxious
- WORRX: Take medication for worried, nervous, or anxious
feelings
- WORFEELEVL: Level of worried, nervous, or anxious feelings, last
time
To analyze the trend of depression prevalence, frequency and level
from 2015 to 2021, we will focus on depression indicators listed
below:
- DEPRX:Take medication for depression
- DEPFREQ:How often feel depressed
- DEPFEELEVL: Level of depression, last time depressed
Core demographic and Social economic status indicators listed below
are also included in this analysis:
- AGE:Age, individuals with age above 85 is excluded from analysis as
85 is the top code.
- SEX:Biological sex
- MARST:Current marital status
- POVERTY:Ratio of family income to poverty threshold
Responses indicate Unknown or not applied are excluded from our
analysis.
anx_dep =
>>>>>>> d5ebf65edd5f26129b716b874dc19aa2c04098db:analysis/anxiety_and_depression_trend_report.html
read_csv("data/nhis_data01.csv") %>%
janitor::clean_names() %>%
filter(year>=2015) %>%
select(year, worrx, worfreq, worfeelevl, deprx, depfreq, depfeelevl, age, sex, marst, poverty) %>%
mutate(
sex = recode_factor(sex,
"1" = "Male",
"2" = "Female"),
marst = recode_factor(marst,
"10" = "Married", "11" = "Married", "12" = "Married", "13" = "Married",
"20" = "Widowed",
"30" = "Divorced",
"40" = "Separated",
"50" = "Never married"),
poverty = recode_factor(poverty,
"11" = "Less than 1.0", "12" = "Less than 1.0",
"13" = "Less than 1.0", "14" = "Less than 1.0",
"21" = "1.0-2.0", "22" = "1.0-2.0",
"23" = "1.0-2.0", "24" = "1.0-2.0",
"25" = "1.0-2.0",
"31" = "2.0 and above","32" = "2.0 and above",
"33" = "2.0 and above","34" = "2.0 and above",
"35" = "2.0 and above","36" = "2.0 and above",
"37" = "2.0 and above","38" = "2.0 and above"),
worrx = recode_factor(worrx,
'1' = "no",
'2' = "yes"),
worfreq = recode_factor(worfreq,
'1' = "Daily",
'2' = "Weekly",
'3' = "Monthly",
'4' = "A few times a year",
'5' = "Never"),
worfeelevl = recode_factor(worfeelevl,
'1' = "A lot",
'3' = "Somewhere between a little and a lot",
'2' = "A little"),
deprx = recode_factor(deprx, '1' = "no", '2' = "yes"),
depfreq = recode_factor(depfreq, '1' = "Daily", '2' = "Weekly",
'3' = "Monthly", '4' = "A few times a year",
'5' = "Never"),
depfeelevl = recode_factor(depfeelevl, '1' = "A lot",
'3' = "Somewhere between a little and a lot",
'2' = "A little"),
age = ifelse(age>=85, NA, age)
)
Anxiety Trend
Percentage of people reported taken medication for worried, nervous,
or anxious feelings
According to the plot, from 2015 to 2021, the percentage of people
who report taking medication for worry, stress or anxiety is constantly
increasing from 9.13% in 2015 to 13.57% in 2021. We can observe a rapid
increase from 2017 to 2019 and, contrary to our expectations, a
relatively slow increase from 2019 to 2020. The effect of COVID-19 on
anxiety is not evident in this plot.
anx_dep %>%
drop_na(worrx) %>%
group_by(year, worrx) %>%
summarize(wor_num = n()) %>%
pivot_wider(
names_from = worrx,
values_from = wor_num
) %>%
mutate(
wor_percentage = yes/(no + yes)*100,
text_label = str_c(yes, " out of ", no + yes)
) %>%
ungroup() %>%
plot_ly(
y = ~wor_percentage,
x = ~year,
color = ~year,
type = "bar",
colors = "viridis",
text = ~text_label
) %>%
layout(
xaxis = list (title = ""),
yaxis = list (title = "Percentage"),
showlegend = FALSE
) %>%
hide_colorbar()
<<<<<<< HEAD:exploratory_analysis.html
## `summarise()` has grouped output by 'year'. You can override using the
## `.groups` argument.
Frequency of worries
nhis %>%
filter(year>=2015) %>%
=======
Stratify by Biological sex
Stratify the reported percentage of people taking medication for
worried, nervous, or anxious feelings by biological sex, we can observe
a much higher percentage among females than males. There is also a
faster increase in the percentage among females from 14.41% in 2018 to
16.52% in 2019. This increase may indicate COVID-19-induced anxiety in
females. Among males, the percentage is relatively stable from 2018 to
2020, while there is an increase from 2020 to 2021.
anx_dep %>%
drop_na(sex, worrx) %>%
group_by(sex, year, worrx) %>%
summarize(wor_num = n()) %>%
pivot_wider(
names_from = worrx,
values_from = wor_num
) %>%
mutate(
wor_percentage = yes/(no + yes)*100,
text_label = str_c(yes, " out of ", no + yes)
) %>%
ungroup() %>%
plot_ly(
y = ~wor_percentage,
x = ~year,
color = ~sex,
type = "bar",
colors = "viridis",
text = ~text_label
) %>%
add_trace(
x = ~year,
y = ~wor_percentage,
color = ~sex,
type='scatter',
mode='lines+markers'
) %>%
layout(
xaxis = list (title = ""),
yaxis = list (title = "Percentage"),
legend = list(orientation = 'h')
)
Stratify by ratio of family income to poverty threshold
Stratify the percentage of people reported taken medication for
worried, nervous, or anxious feelings by the ratio of household income
to the poverty line, we can clearly see that the poorer the household,
the higher their percentage. The percentage among the poorest stratum
decreased rapidly from 17.30% in 2017 to 15.84% in 2018, which is the
opposite of what happened in the other two strata. Although the
percentage of the poorest strata decreased rapidly from 2017 to 2018,
they still had the highest percentage of the three strata, and this
decrease was followed by a rapid increase from 15.84% in 2018 to 18.58%
in 2019, which may indicate that people belonging to the poorest stratum
are more susceptible to anxiety caused by COVID-19. From 2020 to 2021,
the percentage decreases for the other two strata, while for the richest
strata, the percentage steadily increases.
anx_dep %>%
drop_na(poverty, worrx) %>%
group_by(poverty, year, worrx) %>%
summarize(wor_num = n()) %>%
pivot_wider(
names_from = worrx,
values_from = wor_num
) %>%
mutate(
wor_percentage = yes/(no + yes)*100,
text_label = str_c(yes, " out of ", no + yes)
) %>%
ungroup() %>%
plot_ly(
y = ~wor_percentage,
x = ~year,
color = ~poverty,
type = "scatter",
mode = "lines+markers",
colors = "viridis",
text = ~text_label
) %>%
layout(
xaxis = list (title = ""),
yaxis = list (title = "Percentage"),
legend = list(orientation = 'h')
)
Stratify by current martial status
Stratify the percentage of people reported taken medication for
worried, nervous, or anxious feelings by current martial status, we can
observe a rapid increase from 10.61% in 2017 to 15.60% in 2019 among
those widowed, while it is difficult to tell whether this increase is
caused by COVID-19 as it starts at 2017. There is also a rapid increase
among those who are separated, from 14.31% in 2019 to 17.49% in 2020.
Considering the timing, this could be an effect of COVID-19. The trends
are similar for married and never married.
anx_dep %>%
drop_na(marst, worrx) %>%
group_by(marst, year, worrx) %>%
summarize(wor_num = n()) %>%
pivot_wider(
names_from = worrx,
values_from = wor_num
) %>%
mutate(
wor_percentage = yes/(no + yes)*100,
text_label = str_c(yes, " out of ", no + yes)
) %>%
ungroup() %>%
plot_ly(
y = ~wor_percentage,
x = ~year,
color = ~marst,
type = "scatter",
mode='lines+markers',
colors = "viridis",
text = ~text_label
) %>%
layout(
xaxis = list (title = ""),
yaxis = list (title = "Percentage"),
legend = list(orientation = 'h')
)
Age distribution
As we can see from the plot, the age distribution of people taking
medication for worried, nervous, or anxious feelings did not change much
from 2015 to 2021.
anx_dep %>%
drop_na(age, worrx) %>%
ggplot(
aes(x=age, group=worrx, fill=worrx)
) +
geom_density(alpha=0.4) +
facet_wrap(~year) +
labs(
fill = "Whether taken medicine for anxiety"
)
Frequency of worried, nervous, or anxious feelings
From this bar plot about how often people feel worried, nervous, or
anxious, we can observe that the frequency is steadily increasing from
2015 to 2021. There is also a rapid increase from 2019 to 2020, which
could be caused by COVID-19.
anx_dep %>%
>>>>>>> d5ebf65edd5f26129b716b874dc19aa2c04098db:analysis/anxiety_and_depression_trend_report.html
drop_na(worfreq) %>%
group_by(year, worfreq) %>%
summarize(count = n()) %>%
group_by(year) %>%
summarize(
percentage=100 * count/sum(count),
sum_count = sum(count),
worfreq = worfreq,
count=count
) %>%
mutate(
text_label = str_c(count, " out of ", sum_count)
) %>%
plot_ly(
y = ~percentage,
x = ~year,
color = ~worfreq,
type = "bar",
colors = "viridis",
text = ~text_label
) %>%
layout(
xaxis = list (title = ""),
yaxis = list (title = "Percentage"),
barmode = 'stack',
legend = list(orientation = 'h')
)
<<<<<<< HEAD:exploratory_analysis.html
## `summarise()` has grouped output by 'year'. You can override using the
## `.groups` argument.
## `summarise()` has grouped output by 'year'. You can override using the
## `.groups` argument.
worry level distribution.
nhis %>%
filter(year>=2015) %>%
=======
Level of worried, nervous, or anxious feelings
From this bar plot about the level of worried, nervous, or anxious
feelings people felt last time, we can observe a relatively large
increase from 2018 to 2019 in the percentage of people who felt worried,
stressed, or anxious a lot or between a little and a lot, which could be
an effect of COVID-19.
anx_dep %>%
>>>>>>> d5ebf65edd5f26129b716b874dc19aa2c04098db:analysis/anxiety_and_depression_trend_report.html
drop_na(worfeelevl) %>%
group_by(year, worfeelevl) %>%
summarize(count = n()) %>%
group_by(year) %>%
summarize(
percentage=100 * count/sum(count),
sum_count = sum(count),
worfeelevl = worfeelevl,
count=count
) %>%
mutate(
text_label = str_c(count, " out of ", sum_count)
) %>%
plot_ly(
y = ~percentage,
x = ~year,
color = ~worfeelevl,
type = "bar",
colors = "viridis",
text = ~text_label
) %>%
layout(
xaxis = list (title = ""),
yaxis = list (title = "Percentage"),
barmode = 'stack',
legend = list(orientation = 'h')
)
<<<<<<< HEAD:exploratory_analysis.html
## `summarise()` has grouped output by 'year'. You can override using the
## `.groups` argument.
## `summarise()` has grouped output by 'year'. You can override using the
## `.groups` argument.
logistic regression
whether taken medication for worried, nervous, or anxious feelings is
associated with covid-19 adjusting for sex and family income level.
glm(worrx ~ sex + poverty + cvddiag,
family=binomial(link='logit'),
data = recent_yr_df) %>%
broom::tidy(conf.int = TRUE) %>%
mutate(
odds_ratio = exp(estimate),
low = exp(conf.low),
high = exp(conf.high)
) %>%
select(term, odds_ratio, low, high) %>%
knitr::kable(digits=2)
term
odds_ratio
low
high
(Intercept)
0.08
0.07
0.09
sex
2.09
1.98
2.20
poverty
0.98
0.98
0.99
cvddiag
1.07
1.03
1.12
=======
>>>>>>> d5ebf65edd5f26129b716b874dc19aa2c04098db:analysis/anxiety_and_depression_trend_report.html
Depression Trend
Percentage of people reported taken medication for depression
According to the plot, the proportion of people reported taken
medication for depression increased from 8.75% in 2015 to 11.42% in
2020, followed by a slight decrease from 2020 to 2021. COVID-19 appears
to have a limited impact on depression.
anx_dep %>%
drop_na(deprx) %>%
group_by(year, deprx) %>%
summarize(dep_num = n()) %>%
pivot_wider(
names_from = deprx,
values_from = dep_num
) %>%
mutate(
dep_percentage = yes/(no + yes)*100,
text_label = str_c(yes, " out of ", no + yes)
) %>%
ungroup() %>%
plot_ly(
y = ~dep_percentage,
x = ~year,
color = ~year,
type = "bar",
colors = "viridis",
text = ~text_label
) %>%
layout(
xaxis = list (title = ""),
yaxis = list (title = "Percentage"),
showlegend = FALSE
) %>%
hide_colorbar()
<<<<<<< HEAD:exploratory_analysis.html
## `summarise()` has grouped output by 'year'. You can override using the
## `.groups` argument.
Frequency of feel depressed
nhis %>%
filter(year>=2015) %>%
=======
Stratify by Biological sex
Stratify the reported percentage of people taking medication for
depression by biological sex, we can observe a much higher percentage
among females than males. There are also a faster increase in the
percentage among females from 12.68% in 2017 to 15.14% in 2020 and a
decrease from 15.14% in 2020 to 14.52% in 2021. The decrease may
indicate that COVID-19 can be a protective factor against depression
among females. Contrary to females, the percentage slightly decreased
from 2018 to 2019 and then increased from 2020 to 2021 among males.
anx_dep %>%
drop_na(sex, deprx) %>%
group_by(sex, year, deprx) %>%
summarize(dep_num = n()) %>%
pivot_wider(
names_from = deprx,
values_from = dep_num
) %>%
mutate(
dep_percentage = yes/(no + yes)*100,
text_label = str_c(yes, " out of ", no + yes)
) %>%
ungroup() %>%
plot_ly(
y = ~dep_percentage,
x = ~year,
color = ~sex,
type = "bar",
colors = "viridis",
text = ~text_label
) %>%
add_trace(
x = ~year,
y = ~dep_percentage,
color = ~sex,
type='scatter',
mode='lines+markers'
) %>%
layout(
xaxis = list (title = ""),
yaxis = list (title = "Percentage"),
legend = list(orientation = 'h')
)
Stratify by ratio of family income to poverty threshold
Stratify the percentage of people reported taken medication for
depression by the ratio of household income to the poverty line, we can
clearly see that the poorer the household, the higher their percentage.
The percentage among the poorest stratum decreased from 17.41% in 2017
to 16.53% in 2018, which is the opposite of what happened in the other
two strata. The change in the percentage is quite stable from 2018 to
2019 among all three strata. There is a rapid increase from 17.02% in
2019 to 18.66% in 2020, which may indicate that people belonging to the
poorest stratum are affected by COVID-19 related depression. From 2020
to 2021, the percentage decreases for the other two strata, while for
the richest strata, the percentage increases.
anx_dep %>%
drop_na(poverty, deprx) %>%
group_by(poverty, year, deprx) %>%
summarize(dep_num = n()) %>%
pivot_wider(
names_from = deprx,
values_from = dep_num
) %>%
mutate(
dep_percentage = yes/(no + yes)*100,
text_label = str_c(yes, " out of ", no + yes)
) %>%
ungroup() %>%
plot_ly(
y = ~dep_percentage,
x = ~year,
color = ~poverty,
type = "scatter",
mode = "lines+markers",
colors = "viridis",
text = ~text_label
) %>%
layout(
xaxis = list (title = ""),
yaxis = list (title = "Percentage"),
legend = list(orientation = 'h')
)
Stratify by current martial status
Stratify the percentage of people reported taken medication for
depression by current martial status, we can observe a rapid decrease
from 17.26% in 2016 to 13.12% in 2019 among separated, while this
downward trend slows from 2018 to 2019 and reverses from 2019 to 2020.
The trends are similar for married and never married, divorced and
widowed. the effect of COVID-19 is not evident in this plot.
anx_dep %>%
drop_na(marst, deprx) %>%
group_by(marst, year, deprx) %>%
summarize(dep_num = n()) %>%
pivot_wider(
names_from = deprx,
values_from = dep_num
) %>%
mutate(
dep_percentage = yes/(no + yes)*100,
text_label = str_c(yes, " out of ", no + yes)
) %>%
ungroup() %>%
plot_ly(
y = ~dep_percentage,
x = ~year,
color = ~marst,
type = "scatter",
mode='lines+markers',
colors = "viridis",
text = ~text_label
) %>%
layout(
xaxis = list (title = ""),
yaxis = list (title = "Percentage"),
legend = list(orientation = 'h')
)
Age distribution
As we can see from the plot, the age distribution of people taking
medication for depression did not change much from 2015 to 2021.
anx_dep %>%
drop_na(age, deprx) %>%
ggplot(
aes(x=age, group=deprx, fill=deprx)
) +
geom_density(alpha=0.4) +
facet_wrap(~year) +
labs(
fill = "Whether taken medicine for depression"
)
Frequency of depression
From this bar plot about how often people feel depressed, we can
observe that the frequency is quite stable with a decrease from 2018 to
2019 and am increase from 2019 to 2021. There is no clear evidence of an
effect of COVID-19 on the frequency of depression.
anx_dep %>%
>>>>>>> d5ebf65edd5f26129b716b874dc19aa2c04098db:analysis/anxiety_and_depression_trend_report.html
drop_na(depfreq) %>%
group_by(year, depfreq) %>%
summarize(count = n()) %>%
group_by(year) %>%
summarize(
percentage=100 * count/sum(count),
sum_count = sum(count),
depfreq = depfreq,
count=count
) %>%
mutate(
text_label = str_c(count, " out of ", sum_count)
) %>%
plot_ly(
y = ~percentage,
x = ~year,
color = ~depfreq,
type = "bar",
colors = "viridis",
text = ~text_label
) %>%
layout(
xaxis = list (title = ""),
yaxis = list (title = "Percentage"),
barmode = 'stack',
legend = list(orientation = 'h')
)
<<<<<<< HEAD:exploratory_analysis.html
## `summarise()` has grouped output by 'year'. You can override using the
## `.groups` argument.
## `summarise()` has grouped output by 'year'. You can override using the
## `.groups` argument.
depression level distribution.
nhis %>%
filter(year>=2015) %>%
=======
Level of depression
From this bar plot about the level of depression last time, we can
see that the percentage of people who felt a lot or between a little and
a lot depression is stable over the time period and a decrease of
percentage of people feel a lot depression from 2018 to 2019. There is
also no clear evidence of an effect of COVID-19 on the level of
depression.
anx_dep %>%
>>>>>>> d5ebf65edd5f26129b716b874dc19aa2c04098db:analysis/anxiety_and_depression_trend_report.html
drop_na(depfeelevl) %>%
group_by(year, depfeelevl) %>%
summarize(count = n()) %>%
group_by(year) %>%
summarize(
percentage=100 * count/sum(count),
sum_count = sum(count),
depfeelevl = depfeelevl,
count=count
) %>%
mutate(
text_label = str_c(count, " out of ", sum_count)
) %>%
plot_ly(
y = ~percentage,
x = ~year,
color = ~depfeelevl,
type = "bar",
colors = "viridis",
text = ~text_label
) %>%
layout(
xaxis = list (title = ""),
yaxis = list (title = "Percentage"),
barmode = 'stack',
legend = list(orientation = 'h')
)
<<<<<<< HEAD:exploratory_analysis.html
## `summarise()` has grouped output by 'year'. You can override using the
## `.groups` argument.
logistic regression
whether taken medication for depression is associated with covid-19
adjusting for sex and family income level.
glm(deprx ~ sex + poverty + cvddiag,
family=binomial(link='logit'),
data = recent_yr_df) %>%
broom::tidy(conf.int = TRUE) %>%
mutate(
odds_ratio = exp(estimate),
low = exp(conf.low),
high = exp(conf.high)
) %>%
select(term, odds_ratio, low, high) %>%
knitr::kable(digits=2)
term
odds_ratio
low
high
(Intercept)
0.08
0.07
0.09
sex
2.08
1.97
2.20
poverty
0.97
0.97
0.98
cvddiag
1.05
1.00
1.10
=======
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